BOARDING APPLICATION FORM

BURFORD SCHOOL

Please complete this form in full for your child. The information will be used for administrative purposes within the school. The County Council can collect this information

under the Provisions of data Act 1998. This information will be shared with schools and

other educational institutions. The provision of accurate information helps this school and LEA to see that your child and other children get the best from their schooling. It is important that you tell us if there are any changes to the information you give and, from time to time, we may ask you to confirm that it is correct.

SECTION 1: PUPIL’S DETAILS:

Surname Forename:

Middle name(s) Chosen name:

Previous surname (if applicable):

Gender: Male / Female Age at present Date of Birth:

Address:_

Postcode: Home Telephone Number:

Nationality Country of birth

Country of Passport & Number Valid From / To

Current Year Group Year of Entry & Year Group Applying for

How did you hear of Burford Boarding

SECTION 2: PARENTS’ DETAILS:

To fulfil the provisions of the Education (Pupil Registration) Regulations the school is required to keep an admissions register that includes the name and address of every person considered, in law, to be the parent of a pupil. Please note that this includes: mother; married father - even if separated or divorced from the mother; unmarried father – provided parental responsibility is obtained either by formal written agreement of the mother or by court order; any person who has a residence order in relation to the child; any person who has actual care of the child.

Mother’s name: Father’s name:

Mother’s address Father’s address:

Mother’s telephone no. Father’s telephone no.

Mother’s work no: Father’s work no

Mother’s mobile no: Father’s mobile no:

Mother’s email address: Father’s email address:

Mother’s Occupation Father’s Occupation

Is the pupil entitled to state education in the UK YES / NO NB Proof of eligibility may be required

Please indicate whether you are a forces family YES / NO

SECTION 3: EMERGENCY CONTACT (In the first instant the Boarding house will be contacted).

If residing overseas please give name and address of Host Family or Guardianship in the UK.

1) Title Forename Surname

Address

Daytime telephone no:

Home telephone no (if different):

Email address

Relationship to child

SECTION 4: BROTHERS AND SISTERS:

Please indicate the position of your child within the family

eg. eldest of three 1

children (please do not include parents)

SECTION 5: PREVIOUS EDUCATION:

Please give details of all previous settings attended by your child – if any.

Continue on a separate page if there is insufficient space. If possible please provide an email address of current school.

1) Name and address of school or pre-school setting:

Date started: Date left:

2) Name and address of school or pre-school setting:

Date started: Date left:

3) Name and address of school or pre-school setting:_

Date started: Date left:_

Previous Academic Record – Please give results of any Key Stage 2, 3 or GCSE Examinations:

KS2
KS3
GCSE Subjects
and Grades

SECTION 6: ETHNIC MONITORING:

Please tick the ethnic group to which your child belongs. Please note that this question is not about citizenship or nationality. It is essential that we have this information so that we can monitor the effectiveness of the school’s and the LEA’s equal opportunities policies and practices in maximising your child’s progress and achievement. White British should include any pupils for England, Scotland, Wales and Northern Ireland. White Irish should include any pupils from the republic of Ireland.

White British ¨ Pakistani ¨

White Irish ¨ Bangladeshi ¨

White Traveller of Irish heritage ¨ Any other Asian background* ¨

Any other white background* ¨ Black Caribbean ¨

White Gypsy/Roma ¨ Black African ¨

White and Black Caribbean ¨ Any other black background* ¨

White and Black African ¨ Chinese ¨

White and Asian ¨ Any other ethnic group ¨

Any other mixed background* ¨ Prefer not to answer ¨

Indian ¨ *(please specify)______

Please tick the main language spoken by your child at home. Please tick one box only.

English ¨ Gujerati ¨

Punjabi ¨ Chinese (Cantonese / ¨

Urdu ¨ Mandarin)

Bengali /Bangla / Sylheti ¨ Caribbean Creole ¨

Hindi ¨ Any other ¨

Please tick your child’s religion, if you wish. Please tick one box only.

Christian ¨ Jewish ¨

Muslim ¨ Buddhist ¨

Hindu ¨ Other ¨

Sikh ¨ No religion ¨

SECTION 7: NEED FOR BOARDING / LOOKED AFTER:

Does the student have a need for boarding? This includes children at risk or with an unstable home environment, children of service personnel who have died whilst serving or have been discharged as a result of attributable, injury, children of key workers working abroad or Crown Servants working abroad (eg the children of charity workers, people working for voluntary service organisations, the diplomatic service of the European Union, teachers, law enforcement officers and medical staff) whose work dictates that they spend much of the year overseas. YES / NO

If Yes, please provide full details with supporting documentation with this application. The eligibility of a candidate for this category of priority will be assessed on the information supplied.

Is the applicant Looked After by a local authority in England and Wales in accordance with Section 22 of the Children Act 1989 (B)? YES / NO

Was the child looked after previously? YES / NO

If applicable, please attach supporting documents confirming the child was or is Looked After.

SECTION 8: MEDICAL INFORMATION:

Knowledge about children’s health is vital if we are to help them reach their potential educationally. Would you please, therefore, supply the following information about your child. This information will be available to relevant officers at the LEA, school staff and to the school health nurse.

Has your child had his/her pre-school booster? YES ¨ NO ¨ DON’T KNOW ¨

Does your child suffer from: Does your child have any problems with:

Asthma ¨ Mobility ¨

Epilepsy ¨ Behaviour ¨

Diabetes ¨ Hearing ¨

Bowel or bladder conditions ¨ Speech ¨

Serious allergies ¨ Vision ¨

Any other medical conditions ¨ wears glasses: generally o

for reading ¨

If you have answered ‘YES’ to any of the above, please give details:

Does your child need regular medication on prescription? YES o NO o

If yes please advise which medications are being taken and the dosage and frequency.

Has your child had any operations or major injures? YESo NO o

Does your child suffer with any recurrent illnesses? YESo NO o

Does your child have any allergies? YESo NO o

Is your child currently receiving any medical care? YESo NO o

Does your child suffer from any condition which may affect his / her participation in Sport? YESo NO o

If you have answered ‘YES’ to any of the above please give full details:

Would you like an opportunity to discuss your child’s health YESo NO o

with the school?

SECTION 9: YOUR SIGNATURE:

Please sign and date this form below:

Signature Date

Name (in block capitals please) Relationship to child

For School use only

UPN:______Admission Date:______Year_____ Form_____House______